The programmer allows a practitioner to interrogate the implantable device and read the contents of its memories, and to program the implantable device so as to modify its settings or drive the execution of various algorithms, to provide software updates, to operate tests, etc.
Once the implantable device is positioned in a patient, and its leads connected, it is necessary to verify that a plurality of parameters are properly set at the moment of the implantation procedure, and thereafter on a regular basis or from time to time during follow-up visits.
The main parameters to be tested are: sensing sensitivity, lead impedance and capture threshold. These tests are typically performed for both the atrium and ventricle. In the case of a defibrillator, the test also covers the continuity of the shock coil or electrode, and the charging time for the shock capacitor to reach its nominal energy value. Finally, for multi-site devices, notably the implantable devices for cardiac resynchronization therapy (“CRT”), it is also necessary to test the parameters relating to the left ventricle (impedance of the coronary lead for left ventricular pacing, and capture threshold of left ventricular electrode). Performance of these tests is typically controlled by the practitioner, through the programmer.
U.S. Pat. Nos. 7,003,349, 6,618,622 and 5,833,623 describe some devices adapted to the execution of such tests. The practitioner can notably use and create “scripts” that define a sequence of operations through which the different requested tests are automatically linked to perform in sequence, one after the other.
When the practitioner schedules performance of one test, it results in putting the implanted device in a particular operating mode (DDI, DOO, etc.), with a particular pacing rate (the value being either chosen by the practitioner or set by the programmer to a default value) and a particular AV delay. The programmer then collects the operating data of the implanted device with such predetermined settings, and displays on a screen the result of the test thus performed. These tests can be practically launched by pressing a button available to the practitioner (e.g., an actual physical button, or a clickable zone on the screen), with each pressing of the button triggering the corresponding test.
The time required for executing the various tests is a major issue. In the first place, it is highly desirable to shorten the testing phase, for it constitutes a preliminary step to any interpretation or diagnosis, and therefore a dead time throughout the duration of the visit to the practitioner. Furthermore, from the patient's viewpoint, during the tests the implanted device is adjusted with test-specific predetermined settings, and its operation is not that for which it is normally parameterized. The implanted device is therefore not adapted to the patient's physiology throughout the duration required for these tests to be performed. It is therefore highly desirable, for a safety purpose, to abbreviate as much as possible this phase of tests.